AB0263 CLINICAL AND LABORATORY FACTORS ASSOCIATED WITH THE RHEUMATOID CACHEXIA.

Abstract

BackgroundRheumatoid arthritis (RA) is associated with reduced physical performance capacity, leisure activities and self-service [1]. These changes are the results of the destruction of the joints, as well as the decrease in muscle strength, which is known as sarcopenia. However, patients with RA beset with a rheumatoid cachexia (RC), a specific form of sarcopenia, characterized with a decrease in fat-free mass index and an increase in fat mass index [2]. RC leads to a dramatic decrease in the life quality and increase in mortality rate [3].ObjectivesTo study the clinical and laboratory factors associated with the RC.Methods110 patients (102 females and 8 males) were enrolled in our study. All patients fulfilled the 2010 ACR/EULAR classification criteria for RA. Standard clinical, laboratory and instrumental examinations were performed. Additionally, hsCRP, ACPA, CTX-1, P1NP and 25(OH)D were defined. Dual-energy X-ray absorptiometry with Total Body program was performed. The diagnosis of RC was based on the next criteria: fat-free mass index less than 10th percentiles with fat mass index above 25th percentiles [2]. Statistical analysis was performed using a software package “Statistica 12.0”. Parametric parameters are presented as M±std.dev. (95% CI), non-parametrics as Me (Q1-Q3). Intragroup analysis of quantitative indicators was carried out using Student’s or Mann-Whitney test. The multiple logistic regression analysis was performed with a stepwise direct search procedure. Results are presented as odds ratio (OR) and 95% confidence interval (95% CI). ROC curve was plotted to assess the diagnostic significance of quantitative signs in predicting rheumatoid cachexia.ResultsMean patients age was 53,7±12,07 (10,8-13,7) years. More than 85% had severe of terminal progression of the RA. Most patients were RF (77,3%) and ACPA (67,3%) positive, had moderate disease activity (3,79 [2,89-4,40]), cartilage erosions (79%) and II (56,4%) functional class. RC was diagnosed in 25 patients. Prevalence of RC was lower in RF-negative patients (OR 0,11 (95% CI 0,01-0,83). Also, prevalence of RA was associated with the duration of RA (1,06 (1,01-1,11)). Mean cumulative dose of glucocorticoids (GCs) was higher in patients with RC (8,5 g [6,2-17,5 g]), than without (5,8 g [3,6-13,7 g]) (Z=-1,98; p=0,047). Mean daily dose of GCs was lower in patients with RC (5 mg [4-8 mg] and 8 mg [5-10 mg] (Z=2,58; p=0,01)). The median duration of RA was higher among patients with RC (14,0 years [9,0-22,0] vs 8,0 years [3,0-16,0] (Z=-2,18; p=0,029)).ROC-curve was employed to assess the significance of the RF-negativity and RA duration in the diagnosis of RC. Results are presented in Figure 1.Figure 1.ROC-curve for the RC based on the duration of RA and the presence of RF.The optimum cut-off point of 9,5 years of RA was defined using Youden’s J, with a sensitivity of 88% and specificity of 53%.ConclusionRC is associated with the duration of RA, positivity for RF, higher cumulative dose of GCs and lower daily dose of GCs. Due to clinical practice, higher doses of GCs are usually prescribed as a “bridge-therapy” at the start of the treatment or while switching the therapy. On the other side, patients with low daily dose of GCs are more often hormone dependent, with high total cumulative dose. With the sensitivity of 88% patients with the duration of RA 9,5 years and more have RC.References[1]Metsios GS, Kitas GD. Physical activity, exercise and rheumatoid arthritis: effectiveness, mechanisms and implementation. Best Practice & Research Clinical Rheumatology. 2018; 32(5):669-682.[2]Coin A, Sergi G, Minicuci N, Giannini S, Barbiero E, Manzato E, et al. Fat-free mass and fat mass reference values by dual-energy X-ray absorptiometry (DEXA) in a 20-80 year-old Italian population. Clinical Nutrition. 2008; 27(1): 87-94.[3]Roubenoff R. Rheumatoid cachexia: a complication of rheumatoid arthritis moves into the 21st century. Arthritis Research & Therapy. 2009; 11(2): 108.Disclosure of InterestsNone declared